Abstract

Objectives The aim of this study was to evaluate the effects of acupuncture therapy to reduce the duration of postoperative ileus (POI) and to enhance bowel function in cancer patients. Methods A systematic search of electronic databases for studies published from inception until January 2017 was carried out from six databases. Randomized controlled trials (RCTs) involving the use of acupuncture and acupressure for POI and bowel function in cancer patients were identified. Outcomes were extracted from each study and pooled to determine the risk ratio and standardized mean difference. Results 10 RCTs involving 776 cancer patients were included. Compared with control groups (no acupuncture, sham acupuncture, and other active therapies), acupuncture was associated with shorter time to first flatus and time to first defecation. A subgroup analysis revealed that manual acupuncture was more effective on the time to first flatus and the time to first defecation; electroacupuncture was better in reducing the length of hospital stay. Compared with control groups (sham or no acupressure), acupressure was associated with shorter time to first flatus. However, GRADE approach indicated a low quality of evidence. Conclusions Acupuncture and acupressure showed large effect size with significantly poor or inferior quality of included trials for enhancing bowel function in cancer patients after surgery. Further well-powered evidence is needed.

Highlights

  • Bowel dysfunction has been found to be closely related to worse postoperative quality of life, which is regarded as a major outcome measure in surgical oncology [1, 2]

  • A subgroup analysis revealed that manual acupuncture was more effective on the time to first flatus and the time to first defecation; electroacupuncture was better in reducing the length of hospital stay

  • A commonly used clinical end point of postoperative ileus (POI) was the time to recovery of bowel function; the primary therapeutic goal in the treatment of POI is to decrease the time to first flatus and defecation [7]

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Summary

Introduction

Bowel dysfunction has been found to be closely related to worse postoperative quality of life, which is regarded as a major outcome measure in surgical oncology [1, 2]. A temporary impairment of bowel motility lasting within 3–5 days, known as postoperative ileus (POI), is expected after any major surgical procedure, including cancer surgery [3,4,5]. The clinical manifestations of POI include abdominal pain, nausea, vomiting, and delay in the passage of flatus and stool [6]. A commonly used clinical end point of POI was the time to recovery of bowel function; the primary therapeutic goal in the treatment of POI is to decrease the time to first flatus and defecation [7]. POI is associated with discomfort experienced by patients, delayed patient recovery, prolonged length of hospital stay, and increased healthcare costs [8]. The annual economic impact of POI management has been estimated to be over 1.5 billion dollars [11]

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